Infectious complications related to intrathecal drug delivery system and spinal cord stimulator implants at a tertiary care cancer center

Implantable drug-delivery systems provide new means for achieving therapeutic drug concentration over a prolonged time to achieve better tissue protection and enhanced recovery. The hypothesis of the current study was to test the antioxidant and anti-inflammatory effects of genistein and nanofibers on the spinal cord tissue following experimental spinal cord injury (SCI). Rats were treated post SCI with genistein loaded on chitosan/polyvinyl alcohol (CS/PVA) nanofibers as an implantable drug-delivery system. SCI caused marked oxidative damage and inflammation as evident by the reduction in the super oxide dismutase (SOD) activity and the level of interleukin-10 (IL-10) in injured spinal cord tissue, as well as, the significant increase in the levels of nitric oxide (NO), malondialdehyde (MDA) and tumor necrosis factor-alpha (TNF-α). Treatment of rats post SCI with genistein and CS/PVA nanofibers improved most of the above mentioned biochemical parameters and shifted them toward the control group values. Genistein induced an increase in the activity of SOD and the level of IL-10, while causing a decrease in the levels of NO, MDA and TNF-α in injured spinal cord tissue. Genistein and CS/PVA nanofibers provide a novel combination for treating inflammatory nervous tissue conditions, especially when combined as an implantable drug-delivery system.

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Multiple Fibrin Glue Use in a Complicated Case of Postdural Puncture Headache Following Intrathecal Drug Delivery System Placement: A Case Report

Pain Management Case Reports ◽

10.36076/pmcr.2019/3/77 ◽

2019 ◽

pp. 77-81

Author(s):

Matthew Chung

Keyword(s):

Drug Delivery ◽

Cerebrospinal Fluid ◽

Drug Delivery System ◽

Fibrin Glue ◽

Delivery System ◽

Epidural Blood Patch ◽

Csf Leak ◽

Postdural Puncture Headache ◽

Intrathecal Drug Delivery ◽

Blood Patch

A postdural puncture headache (PDPH) is a well-described complication after implantation of an intrathecal drug delivery system (IDDS). Treatment is typically with supportive management with the occasional need for an epidural blood patch. We describe a case of a patient with refractory muscle spasticity secondary to cerebral palsy that required a baclofen IDDS implantation and subsequently developed a PDPH. After failing conservative therapy as well as an epidural blood patch, the decision was made to attempt an epidural fibrin patch, which transiently improved her headache. Upon return of the patient’s symptoms, computed tomography myelogram demonstrated an extensive cerebrospinal fluid leak with ventral spread into the retroperitoneal space. Using a novel technique, a second epidural fibrin glue patch was administered just adjacent to the IDDS catheter insertion point, which was then successful in resolving her symptoms. Key words: Intrathecal drug delivery system, postdural puncture headache, dural tear, cerebrospinal fluid (CSF) leak, fibrin glue, epidural blood patch

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117 Placement of an Intrathecal Drug Delivery System

Atlas of Neurosurgical Techniques ◽

10.1055/b-0036-136839 ◽

2016 ◽

Keyword(s):

Drug Delivery ◽

Drug Delivery System ◽

Delivery System ◽

Intrathecal Drug Delivery

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A Case Report of Reticular Telangiectatic Erythema Following Intrathecal Drug Delivery System Reservoir Replacement

Neuromodulation Technology at the Neural Interface ◽

10.1111/ner.13166 ◽

2020 ◽

Vol 23 (7) ◽

pp. 1054-1056

Author(s):

Logan Kinch ◽

Lynn Kohan

Keyword(s):

Drug Delivery ◽

Case Report ◽

Drug Delivery System ◽

Delivery System ◽

Intrathecal Drug Delivery

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Synthesis and Characterization of a Silica-Based Drug Delivery System for Spinal Cord Injury Therapy

Nano-Micro Letters ◽

10.1007/s40820-019-0252-6 ◽

2019 ◽

Vol 11 (1) ◽

Cited By ~ 2

Author(s):

Guodong Sun ◽

Shenghui Zeng ◽

Xu Liu ◽

Haishan Shi ◽

Renwen Zhang ◽

...

Keyword(s):

Drug Delivery ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Mesoporous Silica ◽

Drug Delivery System ◽

Delivery System ◽

Central Component ◽

High Dose ◽

Interleukin 17 ◽

Cord Injury

Abstract Acute inflammation is a central component in the progression of spinal cord injury (SCI). Anti-inflammatory drugs used in the clinic are often administered systemically at high doses, which can paradoxically increase inflammation and result in drug toxicity. A cluster-like mesoporous silica/arctigenin/CAQK composite (MSN-FC@ARC-G) drug delivery system was designed to avoid systemic side effects of high-dose therapy by enabling site-specific drug delivery to the spinal cord. In this nanosystem, mesoporous silica was modified with the FITC fluorescent molecule and CAQK peptides that target brain injury and SCI sites. The size of the nanocarrier was kept at approximately 100 nm to enable penetration of the blood–brain barrier. Arctigenin, a Chinese herbal medicine, was loaded into the nanosystem to reduce inflammation. The in vivo results showed that MSN-FC@ARC-G could attenuate inflammation at the injury site. Behavior and morphology experiments suggested that MSN-FC@ARC-G could diminish local microenvironment damage, especially reducing the expression of interleukin-17 (IL-17) and IL-17-related inflammatory factors, inhibiting the activation of astrocytes, thus protecting neurons and accelerating the recovery of SCI. Our study demonstrated that this novel, silica-based drug delivery system has promising potential for clinical application in SCI therapy.

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